<style type="text/css" media="screen">

    .weui-cells__title{
        color:#000;
        font-size:17px;
    }
    .weui-cell::before{
      border-top:none;
    }
    .weui-cells::before{
      border-top:none;
    }
    .weui-cells::after{
        border-bottom: none;
    }
    .my-weui-cell{
        /* border-top: 1px solid #e5e5e5; */
        border-bottom: 1px solid #e5e5e5;
    }
    .inline-input {
        border: 1px solid #ccc;
        display:inline;
        width:150px;
    }

    .page__hd {
        /* padding: 0px; */
        padding: 0px 5px;
        padding-top: 10px;
        /* border: 1px solid #000; */
    }
    .page__title{
        margin-top: 5px;
        font-size: 20px;
        color: #333;
        text-align: center;
    }
    .weui-panel__hd
    {
        font-size: 15px;
    }
    .header-img{
        width: 100%;
    }
</style>

<form name="form1" id="form1"  role="form" data-toggle="validator" method="POST" action="">
    <div class='weui-mask_transparent' id="toast">
        <div class="weui-toast weui_loading_toast weui-toast--visible" >
            <div class="weui_loading">
                <i class="weui-loading weui-icon_toast"></i>
            </div>
            <p class="weui-toast_content">数据加载中</p>
        </div>
    </div>
    <div class="page">
        <header class='demos-header'>
            <a href="http://news.qau.edu.cn/channel/yqzty">
                <img src="__CDN__/assets/img/yqbt2.jpg" class="header-img">
            </a>
        </header>
        <div class="page__hd">
            <div class="page__title" id="title">
                  校内工作人员摸排
            </div>
        </div>
        <div class="page__bd">
            <div class="weui-cells weui-cells_form">
                <div class ="my-weui-cell">
                    <div class="weui-cells__title"><label class="weui-label">1.姓名</label></div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="text" required  name='row[nickname]' id='nickname' placeholder="请输入姓名" emptyTips="请输入姓名" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell" id="div_tel">
                    <div class="weui-cells__title" id="tel_lable">2.教工号(没有教工号，填写手机号码)</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="tel" name='row[tel]' id='tel' required  placeholder="请填写" emptyTips="请填写" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">3.当前所在地</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input city-picker" type="text" required  id='current_address' placeholder="请选择当前地址"  emptyTips="当前所在地" >
                            <input  type="hidden"  required id='province_code' name='row[province_code]' >
                            <input  type="hidden" required  id='province' name='row[province]' >
                            <input  type="hidden" required  id='city_code' name='row[city_code]' >
                            <input  type="hidden" required  id='city' name='row[city]' >
                            <input  type="hidden"   id='district_code' name='row[district_code]' >
                            <input  type="hidden"   id='district' name='row[district]' >

                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <!-- <div class ="my-weui-cell" id="div_tel">
                    <div class="weui-cells__title" id="tel_lable">3.日期</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                             <input class="weui-input datetime-picker" name='row[add_time]' required type="text" value="{$add_time}" placeholder="请填写日期" emptyTips="请填写日期" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>


                <div class ="my-weui-cell">
                    <div class="weui-cells__title">5.今日具体行程</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            上午：<input class="weui-input" required type="text"  name='row[morn]' placeholder="请输入上午" ><br/>
                            下午：<input class="weui-input" required type="text"  name='row[after]' placeholder="请输入下午" ><br/>
                            晚上：<input class="weui-input" required type="text"  name='row[night]' placeholder="请输入晚上" ><br/>                           
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div> -->
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">4.人员类别</div>
                    <div class="weui-cells weui-cells_checkbox">
                        
                        <label class="weui-cell weui-check__label" for="r_a21_12">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_21]" value="12" id="r_a21_12" tips="请对第6题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">普通教职工</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a21_13">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_21]" value="13" id="r_a21_13">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">保安、保洁、食堂、超市、物业、图书管理员等高暴露岗位从业人员</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a21_14">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_21]" value="14" id="r_a21_14">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">医护人员含医院辅助工作人员</div>
                        </label>
                        
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">5.本人或共同居住人是否有下列情况？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        
                        <label class="weui-cell weui-check__label" for="r_a1_12">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="12" id="r_a1_12" tips="请对第6题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">确诊病例</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a1_13">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="13" id="r_a1_13">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">疑似病例</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a1_14">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="14" id="r_a1_14">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">无症状感染者</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a1_0">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_1]" value="0" id="r_a1_0" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">无上述情况</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">6.本人或共同居住人是否有下列情况？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a2_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"  name="row[a_2]" value="1" id="r_a2_1" tips="请对第6题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">密切接触者</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a2_2">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_2]" value="2" id="r_a2_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">次密切接触者</div>
                        </label>
                        <!-- <label class="weui-cell weui-check__label" for="r_a2_3">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_2]" value="3" id="r_a2_3">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">与感染者活动时空轨迹重叠的人员或“同时空”伴随人员</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a2_4">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_2]" value="4" id="r_a2_4" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">中高风险地区人员</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a2_5">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_2]" value="5" id="r_a2_5" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">封控区溢出人员</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a2_6">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_2]" value="6" id="r_a2_6" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">管控区溢出人员或防范区溢出人员</div>
                        </label> -->
                        <label class="weui-cell weui-check__label" for="r_a2_7">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_2]" value="7" id="r_a2_7" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">一般接触者</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a2_8">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_2]" value="8" id="r_a2_8" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">其他重点风险人员</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a2_0">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_2]" value="0" id="r_a2_0" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">无上述情况</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>


                <div class ="my-weui-cell">
                    <div class="weui-cells__title">7.本人或共同居住人是否有以下症状未痊愈？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a12_3">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[a_5]" value="3" id="r_a12_3" tips="请对第7题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">发热</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a12_2">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[a_5]" value="2" id="r_a12_2" tips="请对第7题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">咳嗽或咽痛</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a12_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[a_5]" value="1" id="r_a12_1" tips="请对第7题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">乏力、肌肉酸痛、胸闷、恶心呕吐、腹泻、结膜炎等</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a12_0">
                            <div class="weui-cell__hd">
                                <input required type="radio"  class="weui-check"  name="row[a_5]" value="0" id="r_a12_0">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <!-- <div class ="my-weui-cell">
                    <div class="weui-cells__title">8.所在社区（村居）21天内发生疫情？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a3_5">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"  name="row[a_3]" value="1" id="r_a3_5" tips="请对第3题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">有</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a3_0">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_3]" value="0" id="r_a3_0" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">无上述情况</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div> -->
                

                

                
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">8.本人或共同居住人（7天内）是否有疫情重点地区（包括境外、国内中高低风险地区等）旅居史或接触史？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a11_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[a_4]" value="1" id="r_a11_1" tips="请对第8题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       <label class="weui-cell weui-check__label" for="r_a11_2">
                            <div class="weui-cell__hd">
                                <input required type="radio"  class="weui-check"  name="row[a_4]" value="0" id="r_a11_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                
                
               
                
                
                <div class ="my-weui-cell">
                    <div class="weui-cells__title">9.是否当天从省外返鲁？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a6_3">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[a_6]" value="1" id="r_a6_3" tips="请对第9题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       
                        <label class="weui-cell weui-check__label" for="r_a6_0">
                            <div class="weui-cell__hd">
                                <input required type="radio"  class="weui-check"  name="row[a_6]" value="0" id="r_a6_0">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell" id="a_6_shi" style="display:none;">
                    <div class="weui-cells__title" id="tel_lable">请填写省外地级市</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="text" name='row[shengwai_other]' placeholder="请填写省外地级市" emptyTips="请填写省外地级市" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">10.是否当天从省内其他地级市返青？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a7_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[a_7]" value="1" id="r_a7_1" tips="请对第10题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">是</div>
                        </label>
                       
                        <label class="weui-cell weui-check__label" for="r_a7_0">
                            <div class="weui-cell__hd">
                                <input required type="radio"  class="weui-check"  name="row[a_7]" value="0" id="r_a7_0">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">否</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                <div class ="my-weui-cell" id="a_7_shi" style="display:none;">
                    <div class="weui-cells__title" id="tel_lable">请填写省内地级市区</div>
                    <div class="weui-cell">
                        <div class="weui-cell__bd">
                            <input class="weui-input" type="text" name='row[sheng_other]' placeholder="请填写省内地级市区" emptyTips="请填写省内地级市区" >
                        </div>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">11.当天进入校区</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a17_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[is_into]" value="1" id="r_a17_1" tips="请对第11题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">城阳校区</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a17_2">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[is_into]" value="2" id="r_a17_2" tips="请对第11题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">平度校区</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a17_3">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[is_into]" value="3" id="r_a17_3" tips="请对第11题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">蓝谷校区</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a17_4">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[is_into]" value="4" id="r_a17_4" tips="请对第11题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">莱阳校区</div>
                        </label>                       
                        <label class="weui-cell weui-check__label" for="r_a17_0">
                            <div class="weui-cell__hd">
                                <input required type="radio"  class="weui-check"  name="row[is_into]" value="0" id="r_a17_0">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">未入校</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">12.是否当天进行核酸检测？</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a18_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"   name="row[is_nucleic]" value="1" id="r_a18_1" tips="请对第12题做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">校内检测</div>
                        </label>
                       
                         <label class="weui-cell weui-check__label" for="r_a18_2">
                            <div class="weui-cell__hd">
                                <input required type="radio"  class="weui-check"  name="row[is_nucleic]" value="2" id="r_a18_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">校外检测</div>
                        </label>

                        <label class="weui-cell weui-check__label" for="r_a18_0">
                            <div class="weui-cell__hd">
                                <input required type="radio"  class="weui-check"  name="row[is_nucleic]" value="0" id="r_a18_0">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">未检测</div>
                        </label>
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>
                

                <div class ="my-weui-cell">
                    <div class="weui-cells__title">13.今日体温范围</div>
                    <div class="weui-cells weui-cells_checkbox">
                        <label class="weui-cell weui-check__label" for="r_a9_0">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check"  name="row[a_9]" value="0" id="r_a9_0" tips="请对今日体温范围做出选择">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">36&#176;C以下</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a9_9">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="9" id="r_a9_9" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">36&#176;C-37.2&#176;C</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a9_10">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="10" id="r_a9_10" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">37.3&#176;C-38.0&#176;C</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a9_11">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="11" id="r_a9_11" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">38&#176;C以上</div>
                        </label>
                       <!-- <label class="weui-cell weui-check__label" for="r_a9_1">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="1" id="r_a9_1">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">36&#176;C-36.5&#176;C</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a9_2">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="2" id="r_a9_2">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">36.6&#176;C-36.9&#176;C</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a9_3">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="3" id="r_a9_3">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">37&#176;C-37.2&#176;C</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a9_4">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="4" id="r_a9_4">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">37.3&#176;C-37.9&#176;C</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a9_5">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="5" id="r_a9_5">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">38&#176;C-38.5&#176;C</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a9_6">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="6" id="r_a9_6">
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">38.6&#176;C-38.9&#176;C</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a9_7">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="7" id="r_a9_7" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">39&#176;C-40&#176;C</div>
                        </label>
                        <label class="weui-cell weui-check__label" for="r_a9_8">
                            <div class="weui-cell__hd">
                                <input required type="radio" class="weui-check" name="row[a_9]" value="8" id="r_a9_8" >
                                <i class="weui-icon-checked"></i>
                            </div>
                            <div class="weui-cell__bd">40&#176;C以上</div>
                        </label> -->
                        <div class="weui-cell__ft">
                            <i class="weui-icon-warn"></i>
                        </div>
                    </div>
                </div>


                <div class="weui-panel">
                    <div class="weui-panel__hd">
                        <input type="checkbox" name="promise" id="promise" >
                        <label style="color:red;font-size: 14px;">
                            本人承诺以上填报数据真实有效。（请打勾后提交数据）
                        </label>
                    </div>
                </div>

                <input type="hidden" name="row[lat]" id="lat" value="">
                <input type="hidden" name="row[lon]" id="lon" value="">
                <input type="hidden" name="group_id" id="group_id" value="2">


                <!-- <a href="javascript:;" id="datePickerBtn" class="weui-btn weui-btn_default">DatePicker</a> -->

            <div  style="margin-top: 15px;">
                <button id="formSubmitBtn" type="button" disabled class="weui-btn weui-btn_disabled weui-btn_success">提交</button>
            </div>
        </div>
    </div>
</form>
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